Challenge Island - Kincaid Elementary School Foundation

Challenge Island
@Kincaid
Fall 2016
Tuesdays 2:30-3:30
August 23 - December 13 2016 $215
www.challenge-island.com
What is Challenge Island? Challenge Island® is where engineering meets imagination! It’s a
one of a kind enrichment program on the cutting edge of S.T.E.A.M (Science,Technology, Engineering,
Art and Math) Education and 21st Century Learning. Inspired by a popular reality TV show, each
semester of Challenge Island takes place on a unique thematic island where our adventurous tribes
tackle high-level thinking and engineering challenges at whimsical weekly destinations.
This Session’s Island: During the Fall 2016 session,students will “travel” to our all new Amusement Park
THRILLS and CHILLS Islands®! There, they will create thrill rides and attractions galore at action-packed
locations like Roller Coaster Cliff®, Haunted House Harbor®, Rocket Heights®, and the CI Funhouse®. This thrilling
session of Challenge Island® promises to be one of the hottest tickets around, so reserve your spot today!
Registration: Registration may be completed by mailing in the form below - along with a check
made out to “KIDSPLORATIONS LLC” c/o Sharon Estroff 4590 Lasalle Court Marietta, GA
30062 or register online via credit card at www.challenge-island.com/marietta. Contact us at info@challenge-island.com (404) 692-3103
Challenge Island: Kincaid Elementary
Name____________________________ M/F Grade_____ Teacher____________________
Parent Name(s)________________________ Phone 1________________ Phone 2________________
Email (please print clearly) _______________________________ Home Address________________________
Allergies/Medical/Academic/Socio-Emotional Concerns______________________________________
(Please use the back of this sheet to include more information. Please specify symptoms of allergic reaction that require Epipen administration.)
Tribal Friend Request (not required) ______________________ ASP or Pick Up (Circle one)
Students will be brought to ASP or car line after club dismissal. *Please Note: S tudents that are not picked up by3:40pm will be placed in ASP. ASP fees apply.
*I agree to allow Challenge Island to take photographs in connection with this class. Copyright will be owned by Challenge Island Global and may
be used for keepsakes, group slideshows, and/or marketing purposes.
Parent Signature____________________________________OR Please do not photograph my child_______
Refund Policy: No refunds given after the first day of class. If class goes into a waitlist, refunds will only be given if your child’s spot is filled. CI
reserves the right to release a child from the class with not refund if the child’s conduct is a danger or significant distraction to the other students
Release: **I hereby agree to release and hold harmless Kincaid Elementary School Foundation, its officers, trustees, and representatives and
Challenge Island (Kidsplorations LLC), its employees and representatives, from any responsibility, loss, liability, damage or costs which Participant
may incur in this after school program whether caused by the negligence of the Foundation and/or Challenge Island. the negligence of Participant
and/or others, or due to accidental occurrences. In the case of injury or medical emergency involving Participant, if a parent or guardian cannot be
reached, I give Challenge Island program representative(s) permission to seek appropriate first aid or medical care and I agree to be fully
responsible for the cost of any services provided.
Name/Relationship to Child _______________________________________ Date ______________